Cases Of Acute Bacterial Meningitis Research Articles

Cerebrospinal fluid markers to distinguish bacterial meningitis from cerebral malaria in children

Background. Few hospitals in high malaria endemic countries in Africa have the diagnostic capacity for clinically distinguishing acute bacterial meningitis (ABM) from cerebral malaria (CM). As a result, empirical use of antibiotics is necessary. A biochemical marker of ABM would facilitate precise clinical diagnosis and management of these infections and enable rational use of antibiotics. Methods. We used label-free protein quantification by mass spectrometry to identify cerebrospinal fluid (CSF) markers that distinguish ABM (n=37) from CM (n=22) in Kenyan children. Fold change (FC) and false discovery rates (FDR) were used to identify differentially expressed proteins. Subsequently, potential biomarkers were assessed for their ability to discriminate between ABM and CM using receiver operating characteristic (ROC) curves. Results. The host CSF proteome response to ABM (Haemophilus influenza and Streptococcus pneumoniae) is significantly different to CM. Fifty two proteins were differentially expressed (FDR<0.01, Log FC≥2), of which 83% (43/52) were upregulated in ABM compared to CM. Myeloperoxidase and lactotransferrin were present in 37 (100%) and 36 (97%) of ABM cases, respectively, but absent in CM (n=22). Area under the ROC curve (AUC), sensitivity, and specificity were assessed for myeloperoxidase (1, 1, and 1; 95% CI, 1-1) and lactotransferrin (0.98, 0.97, and 1; 95% CI, 0.96-1). Conclusion. Myeloperoxidase and lactotransferrin have a high potential to distinguish ABM from CM and thereby improve clinical management. Their validation requires a larger cohort of samples that includes other bacterial aetiologies of ABM.

Clinical profile, bacterial profile and outcomes of acute bacterial meningitis in a tertiary care hospital– one year study

Background: Bacterial meningitis is still one of the major causes of mortality and morbidity among all groups in developing countries. The mortality and prevalence of common pathogens has reduced in developing countries with implementation of successful vaccination against the pathogens. Laboratory surveillance of pathogens is crucial in formulating the empirical treatment guidelines and to identify the targets of immunization. The present study was undertaken to evaluate the clinical profile, bacterial pathogens and their antibiotic sensitivity pattern of the pathogens. The outcome of the cases was recorded and followed for six months to detect any neurological sequelae.Methods: A one year prospective cross sectional study was done and all suspected cases of acute bacterial meningitis (ABM) were screened and confirmed by diagnostic criteria. Clinical features were recorded and entered into the case sheet. CSF culture was done and biochemical analysis and cell counts were performed. All the data was entered in Microsoft excel and analysed.Results: A total of 547 cases were screened and 282 confirmed with 164 males and 116 females. 282 pathogens were isolated with 266 bacterial and 12 fungal isolates. Gram negative bacterial pathogens were predominant than gram positive. Streptococcus pneumoniae was the common isolate in the study followed by others like S. aureus, Coagulase negative staphylococci and Acinetobacter sp., Escherichia coli, Klebsiella pneumoniae and meningococci. Candida albicans and Cryptococcus sp. were fungal pathogens. Community acquired meningitis was commonest cause and seen in 51-60 years of age. Gram positive pathogens exhibited maximum sensitivity to vancomycin and linezolid whereas Gram negative pathogens to carbapenems.Conclusions: There is an overwhelming need to formulate policies in the management of cases of ABM. The rationale use of antibiotics is necessary to prevent the development of antibiotic resistance. Hence minimizing the emergence of antibiotic resistance and its spread is necessary, which can be achieved by regular prevalence and antibiotic susceptibility studies.

WHO Prognostic Scoring Scale in Acute Bacterial Meningitis of Children: A Prospective Study

Background: Acute Bacterial Meningitis (ABM) is one of the most severe infectious diseases in childhood. The global burden of the disease is high. Various factors that determine the outcome of the diseases are age, early diagnosis, early treatment, duration of treatment and type of microorganism. This study aimed to describe clinical and bacteriological profile of ABM and to correlate the WHO prognostic scoring scale and outcome of children with ABM. Methods: A hospital based prospective study was carried out in Pediatric Medical Units of Mandalay Children’s Hospital during February 2009 to February 2010. Total of 62 children (3 months to 12 years) with confirmed ABM were included in the study. Results: Among 62 cases of ABM, most cases occur in three months to one year age group. The most common presenting features were fever, seizures, lethargy and altered consciousness. Meningeal irritation signs including neck stiffness, positive Kernig and Brudinzski signs were detected in 27.41% to 38.7%. Gram positive and gram negative organisms were detected in 15 cases by CSF gram stain and organisms were isolated in 4 cases by CSF culture. WHO prognostic scoring scale 9 and the patient expired.

The level of neuron-specific enolase and S-100 protein in the cerebrospinal fluid of patients with acute bacterial meningitis

Aim. To evaluate the diagnostic and prognostic role of neuron-specific enolase (NSE) and S-100 protein levels in cerebrospinal fluid (CSF) of patients with acute bacterial meningitis in the course of the disease.Materials and Methods. 54 cases of acute bacterial meningitis were analyzed, among them – 26 with pneumococcal and 28 with meningococcal etiology. Patients were divided into groups depending on the severity and etiology of disease. In addition to routine laboratory methods, we analyzed the CSF levels of S-100 protein and NSE at admission and after 10 – 12 days of treatment. 12 patients with acute respiratory infections and meningism were examined as a comparison group.Results. In all patients with acute bacterial meningitis CSF NSE and protein S-100 levels were significantly higher than in the control group (P <0,05). CSF neuro specific proteins level was in direct dependence on severity of the disease, and in patients with severe disease was significantly higher than in patients with moderate severity and in the control group (P <0,01). After 10 – 12 days of treatment, the level of the NSE and S-100 protein decreased, but in severe cases was still higher than in the control group (P <0,05).Conclusions. Increased cerebrospinal fluid NSE and S – 100 protein levels shows the presence and value of neurons and glial cells damage in patients with acute bacterial meningitis. CSF S-100 protein and neuron-specific enolase levels help to determine the severity of neurons destruction and glial cells in patients with acute bacterial meningitis. Level of neurospecific protein is in direct proportion to the severity of the disease and is the highest in patients with severe cases (P<0,05). It confirms the diagnostic and prognostic value of CSF neurospecific protein determination in patients with bacterial meningitis.

Dynamics of germs responsible for acute bacterial meningitis in Burkina Faso in the last ten years (2005-2014)

The aim of this study was to analyze ten (10) years of epidemiological surveillance data of meningitis in Burkina Faso for high risk germs patterns identification in order to contribute to the strengthening of prevention strategies. A retrospective study of the past decade (2005- 2014) of cases of acute bacterial meningitis occurred in the thirteen health regions, collected through epidemiological surveillance data meningitis in Burkina Faso. From a total of 88 057 suspected cases of acute bacterial meningitis, we recorded 9134 deaths. From the laboratory confirmed cases, the identified germs were as follows: 56.79% of Neisseria meningitidis , 41.09% of Streptococcus pneumoniae and 2.13% of Haemophilus influenzae . Among the meningococcus isolated, we observed the following distribution: 23.11% of NmA, 58.84% of NmW and 18% of NmX. Mortality associated with acute bacterial meningitis remains still high in Burkina Faso despite the complete disappearance of NmA since 2012, after the conjugate vaccine A (MenAfriVac) has been introduced in this country. However the emergence of NmX, the reemergence of NmW and the persistence of high prevalence of Streptococcus pneumoniae are a major concern in the fight against meningitis in Burkina Faso. So, it is necessary, in addition to the strengthening of surveillance, diagnosis and case management to develop and make available and accessible a conjugate trivalent vaccine against NmA the NmX and NmW serogroups. Keywords: meningococcal meningitis, W and X serogroups, Streptococcus pneumoniae, MenAfriVac

Group B streptococcal meningitis in children beyond the neonatal period in sub-Himalayan India.

Objectives:To evaluate clinicolaboratory profile and the outcomes in children (1 to 59 months) diagnosed with Group B streptococcus (GBS) meningitis over a period of 1 year.Materials and Methods:Cerebrospinal fluid (CSF) samples of 250 pediatric patients (1 to 59 months) admitted with suspected acute bacterial meningitis(ABM)were subjected to cell count, biochemical profile, culture, latex particle agglutination (LPA) and polymerase chain reaction (PCR). They were also evaluated for complications and were followed-up till 6 months after discharge.Results:Forty patients (25 boys and 15 girls), 16% of total suspected cases of ABM were diagnosed with GBS by LPA method and 30 (75%) out of these were above 3 months of age. The median duration of hospital stay was 7 days (range 1 to 72 days). State of coma was observed in two (5%) and one (2.5%) died, while 20 (50%) patients recovered completely.Conclusion:GBS should be considered as an important cause of ABM in Indian children beyond the neonatal period and further studies are warranted to determine the actual problem of the disease in our country.

Meningite Bacteriana Aguda como Doença Ocupacional

Streptococcus suis is a zoonotic pathogen with worldwide distribution, responsible for more than 700 human cases globally reported. This infection affects mostly men, exposed to pig or pork, which leads to its usual classification as an occupational disease. We report a case of acute bacterial meningitis in a 44 years old male. According to his past medical history, the patient had chronic alcoholism and worked in a restaurant as a piglet roaster. Microbiological examination of blood and CSF revealed S. suis. After 14 days of ceftriaxone the patient fully recovered. The authors review the clinical reports previously described in Portugal. In all of them was possible to identify risk exposition to pork. We alert to this microorganism's importance in Portugal where it is probably underdiagnosed.

Bakteriyel Menenjitte Epidemiyoloji, Korunma ve Meningokok Serogrup B Enfeksiyonu

Acute bacterial meningitis (ABM) continues to be associated with high mortality and morbidity, despite advances in antimicrobial therapy. The causative organism varies with age, immune function, immunization status, and geographic region, and empiric therapy for meningitis is based on these factors. Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and Neisseria meningitidis cause the majority of cases of ABM. Disease epidemiology is changing rapidly due to immunization practices and changing bacterial resistance patterns. Hib was the leading cause of meningitis in children prior to the

Study of bacterial meningitis in children below 5 years with comparative evaluation of gram staining, culture and bacterial antigen detection.

Bacterial meningitis is one of the most serious infections seen in infants and children, which is associated with acute complications and chronic morbidity. Infections of Central Nervous System (CNS) still dominate the scene of childhood neurological disorders in most of the developing tropical countries. To isolate, identify and determine the antibiotic susceptibility patterns of pathogens associated with bacterial meningitis. We also aimed to comparatively evaluate of Gram staining, culture and bacterial antigen detection in cerebrospinal fluid samples. Present comparative study included 100 CSF samples of children below the age of 5 years, who were clinically suspected meningitis cases. The samples were subjected to Gram staining, culture and Latex agglutination test (LAT). The organisms isolated in the study were characterized and antibiotic susceptibility test was done according to standard guidelines. It was done by using Gaussian test. Of the 100 cases, 24 were diagnosed as Acute bacterial meningitis (ABM) cases by. Gram staining, culture and latex agglutination test. 21 (87.5%) cases were culture positive, with 2 cases being positive for polymicrobial isolates. Gram staining was positive in 17 (70.53%) cases and LAT was positive in 18 (33.33%) cases. Streptococcus pneumoniae was the predominant organism which was isolated and it was sensitive to antibiotics. In the present study, male to female ratio was 1.27:1, which showed a male preponderance. With the combination of Gram staining, culture, and LAT, 100% sensitivity and specificity can be achieved (p < 0.001). Gram staining and LAT can detect 85% of cases of ABM. Bacterial meningitis is a medical emergency and making an early diagnosis and providing treatment early are life saving and they reduce chronic morbidity.

Latex Agglutination Test for Early Detection of Causative Organism in Acute Bacterial Meningitis

Introduction: Acute bacterial meningitis is one of the leading causes of mortality and morbidity in children. Identification of the causative organism is crucial to its management and outcome. The objective of this study was to see the usefulness of latex agglutination test in the early diagnosis of acute bacterial meningitis. Materials and Methods: A hospital based prospective cross-sectional study was conducted at Kanti Children’s Hospital during December 2004 to August 2005. Cerebrospinal fluid from 150 consecutive clinically suspected cases of acute bacterial meningitis between the age group of 2 months to 14 years were analyzed. Bacterial culture and latex agglutination test was done on cerebrospinal fluid obtained from all 150 suspected cases of acute bacterial meningitis. Latex agglutination test was done using the BD DirectigenTM Meningitis Combo test kit (Becton, Dickinson and company, USA) for Streptococcus pneumoniae, group B Streptococcus, Escherichia coli, Neisseria meningitidis group A,C and Y/ W135, and Hemophilus influenzae type b. Data was analysed by using SPSS Version 11.5. Results: Of the 150 Cerebrospinal fluid samples analysed bacterial culture identified only 4 meningitis cases giving an isolation rate of 1.3% whereas latex agglutination test identified 29 cases giving an isolation rate of 19.3% from 150 samples. Streptococcus pneumoniae, Hemophilus influenzae type b and Group B Streptococcus were the most common causative organism. Conclusion: Latex agglutination test has a better yield, higher sensitivity, provides microbiological diagnosis earlier than the traditional cerebrospinal fluid culture and is easy to perform. DOI: http://dx.doi.org/10.3126/jnps.v33i1.7047 J Nepal Paediatr Soc. 2013;33(1):34-38

Role of CSF C-Reactive Protein for the Differentiation of Bacterial Meningitis from Aseptic Meningitis in Children

Background: Acute bacterial meningitis (ABM) is one of the common causes of morbidity and mortality in children. Easy and early diagnostic tool is required for rapid detection of acute bacterial meningitis to reduce mortality and morbidity. Objectives: The study was conducted with the aim to identify the importance of cerebrospinal fluid C- reactive protein (CSF-CRP) to establish the diagnosis of ABM, and to measure the specificity, sensitivity, positive and negative predictive values of CSF-CRP in the diagnosis of Acute Bacterial Meningitis. Methods: This prospective study was carried out in Dhaka Shishu (Children) Hospital during the period of December 2004 to April 2005. Children admitted between age 0- 12 years with fever and convulsion were screened. Patients were divided into three groups on the basis of CSF findings- bacterial meningitis, aseptic meningitis and no meningitis control group. Only CSF culture proven cases were selected as ABM. CSF CRP was measured in all cases along with CSF cytology, biochemistry and culture-sensitivity. Complete were blood count, random blood sugar and other tests also done to treat all cases. All patients were treated adequately (if culture positive according to sensitivity) and were monitored as long as they stayed in hospital. Outcome was assessed clinically during discharge. Results: Twenty patients had acute bacterial meningitis, 15 aseptic meningitis, and 15 cases CSF findings normal and taken as control. CSF-CRP was positive (&gt;6mg/ L) in 35% of the cases of ABM but it was found negative in all aseptic meningitis and in the control groups. Sensitivity of CSF -CRP was low (35%) but specificity was high (100%). The positive predictive value of CSF-CRP was 100% and negative predictive value 53.6%. Among the organisms isolated from acute bacterial meningitis, H. influenzae was the leading pathogen (40%) in infancy followed by S. pneumoniae (35%) and N. meningitidis (5%). Out come of the treatment of CSF-CRP positive ABM cases was found poor (p= 0.035). Conclusion: It is concluded from the study that significant(&gt;6mg/L) level of CRP in CSF is highly specific for diagnosis of ABM and ruled out aseptic meningitis. But negative CSF-CRP could neither exclude pyogenic meningitis nor did it rule out aseptic meningitis. DOI: http://dx.doi.org/10.3329/bjch.v36i3.14275 BANGLADESH J CHILD HEALTH 2012; VOL 36 (3) : 126-132

Acute Bacterial Meningitis in Infants and Children

Acute bacterial meningitis (ABM) continues to be associated with high mortality and morbidity, despite advances in antimicrobial therapy. The causative organism varies with age, immune function, immunization status, and geographic region, and empiric therapy for meningitis is based on these factors. Haemophilus influenzae type b (Hib), Streptococcus pneumoniae, and Neisseria meningitidis cause the majority of cases of ABM. Disease epidemiology is changing rapidly due to immunization practices and changing bacterial resistance patterns. Hib was the leading cause of meningitis in children prior to the introduction of an effective vaccination. In those countries where Hib vaccine is a part of the routine infant immunization schedule, Hib has now been virtually eradicated as a cause of childhood meningitis. Vaccines have also been introduced for pneumococcal and meningococcal diseases, which have significantly changed the disease profile. Where routine pneumococcal immunization has been introduced there has been a reported increase in invasive pneumococcal disease due to non-vaccine serotypes. In those parts of the world that have introduced conjugate meningococcal vaccines, there has been a significant change in the epidemiology of meningococcal meningitis. As a part of the United Nations Millennium Development Goal 4, the WHO has introduced a new vaccine policy to improve vaccine availability in resource poor countries. In addition, antibiotic resistance is an increasing problem, especially with pneumococcal infection. Effective treatment focuses on early recognition and use of effective antibiotics. This review will attempt to focus on the changing epidemiology of ABM in pediatric patients due to vaccination, the changing patterns of infecting bacterial serotypes due to vaccination, and on antibiotic resistance and its impact on current management strategies.

Acute Bacterial Meningitis Cases Diagnosed by Culture and PCR in a Children’s Hospital Throughout a 9-Year Period (2000–2008) in Athens, Greece

Acute bacterial meningitis is one of the most severe infectious diseases, affecting mainly infants and, secondarily, older children and adolescents. Diagnosis in the early stages is often difficult and despite treatment with appropriate antibiotic therapy, the case fatality rate remains high. In the present study, the incidence of bacterial meningitis was registered in a general pediatric hospital in Athens, Greece, during a 9-year period (2000-2008), and the use of molecular methods in the diagnosis of bacterial meningitis versus the conventional cultural methods was evaluated. The impact of vaccination against meningitis-causing bacteria on the incidence of bacterial meningitis was also assessed. From a total of 1833 children hospitalized with suspected clinical symptoms and signs of meningitis, all cerebrospinal fluid (CSF) and blood samples were analyzed by white blood cell (WBC) count, measurement of glucose, protein, and C-reactive protein (CRP) levels, as well as by conventional bacteriologic culture methods. If samples showed altered CSF markers that were consistent with meningitis in general, they were further investigated by PCR for bacterial pathogens. Of the 1833 patients, 289 (15.76%) were found to be positive for meningitis after CSF examination, based on white blood cell count and differentiation, glucose, protein, and CRP. Fifty-six of the 289 (19.37%) had confirmed bacterial meningitis, as diagnosed by either culture and/or PCR. Of these 56 cases, 44 (78.6%) were detected only by PCR, and 12 cases (21.4%) were confirmed by PCR and culture. The predominant microorganism was Neisseria meningitidis serogroup B (n = 40; 71.4%), followed by Streptococcus pneumoniae not typed [NT] (n = 7; 12.5%), Streptococcus spp. (n =4; 7.1%), Haemophilus influenzae NT (n = 2; 3.6%), and S. pneumoniae serotype 3, Streptococcus group B, and S. pneumoniae serotype 18C (each n = 1; 1.8%). In Greece, according to data from the National Meningitis Reference Laboratory, vaccination against N. meningitidis serogroup C since 2001 led to a 10-fold decrease in the incidence of meningitis cases, vaccination against S. pneumoniae serotypes included in the heptavalent conjugate vaccine since 2005 led to a 3.4-fold incidence decrease, and vaccination against H. influenzae type b since 1992 led almost to an absence of cases. In the population of the present study, none of the cases were caused by the above-mentioned vaccine pathogens, except for one S. pneumoniae serotype 18C case with no history of past vaccination. The introduction of vaccination against meningitis-causing bacteria has drastically decreased the emergence of the infection. The improved molecular amplification assays proved to be superior to conventional bacteriologic methods and should be introduced into routine diagnosis, as well as the epidemiologic surveillance of bacterial meningitis.

Clinical and bacteriological spectrum of community-acquired acute bacterial meningitis in adults at a tertiary care hospital in northern India

Objective : To evaluate the clinical and bacteriological spectrum of community-acquired acute bacterial meningitis (ABM) in an adult population at Lok Nayak Hospital, New Delhi, a tertiary care hospital in northern India. Materials and Methods: Cerebrospinal fluid (CSF) samples from 120 clinically suspected cases of pyogenic meningitis were processed for cell counts, differential counts, bacterial stain and culture, antibiotic susceptibility test, and bacterial antigen detection by latex agglutination test (LAT) in CSF, serum and urine. Results : CSF LAT was positive in 56/120 cases of ABM. Streptococcus pneumoniae was the predominant pathogen in 41 of these 120 cases i.e. 34.0% of all cases. Neisseria meningitidis accounted for 24 cases i.e. 20% of all cases. Staphylococcus aureus was isolated in one case. Bacterial cultures were positive in 22 (18.3%) cases only. Conclusions: Evidence for presence of microbial activity could be detected in 44.1% cases by LAT, whereas a direct microbiological confirmation could be documented in only 22 cases i.e. 18.3%. Streptococcus pneumoniae remains the major etiological agent of ABM in our study. Penicillin resistance was detected in 50% of cases among the isolates which came positive by culture. Neisseria meningitidis was detected in 24 cases. But since none were cultured, sensitivity patterns could not be correlated. LAT is a convenient and rapid test to support bacterial etiology in ABM. In remote situations, their use in serum or urine needs to be considered after evaluation in longer studies. Further research should focus on the preventable aspects of ABM, especially pneumococcal and meningococcal vaccines, to potentially protect susceptible groups.

Epidemiological profile of acute bacterial meningitis in the state of Rio Grande do Norte, Brazil

Acute bacterial meningitis (ABM) remains a public health problem in Brazil. To evaluate the epidemiology of ABM cases at Giselda Trigueiro Hospital, Rio Grande do Norte, a descriptive retrospective survey was conducted covering 2005 to 2008. Clinical and laboratory data were collected from the epidemiology department of the hospital and analyzed. Out of 168 ABM cases, 24.4%, 10.7%, and 2.4% were, respectively, caused by Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenza b, and 5.4% by other bacteria. The mean age was 22.48 +/- 18.7 years old. Streptococcus pneumoniae was the main causative pathogen in the young urban population.

Meningitis aguda bacteriana en ancianos

Introduction The age distribution of acute bacterial meningitis (ABM) has shifted from children to adults. At the same time, older population is increasing. The aim of this study is to characterize ABM in elderly patients. Material and methods We reviewed the meningitis cases diagnosed at our hospital (1982–2006), including ABM cases defined by established criteria. Two groups were analyzed: elderly patients (aged ≥60) and young adults (aged 14–59). Results Ninety-five of 239 ABM (40%) were diagnosed in elderly patients, while 144 (60%) were found in younger adults. In elderly people, 32% were nosocomial, 49% had postoperative risk factors, and 24% were spontaneous infections. The combination of fever, neck stiffness, and altered mental status was present in 45%. Elderly people presented altered mental status more often ( p=0,002), had higher protein level ( p=0,023) and higher percentage of positive cerebrospinal fluid culture ( p=0,039). The most common pathogens were Streptococcus pneumoniae (20%), coagulase-negative Staphylococcus (14%) and Listeria monocytogenes (8%), whereas meningitis of unknown etiology was less common ( p=0,014). Elderly patients had a higher mortality rate (19% vs. 6%, p=0,001), closely related to: age ≥75 years, altered mental status, absence of headache or vomiting, development of complications and systemic complications, and infection by Staph. aureus. In the multivariate model, age ≥75 years [OR=6,65; p=0,008], absence of headache [OR=0,15; p=0,003], and development of complications [OR=4,55; p=0,015] remained significantly associated with mortality. Conclusions In elderly people, ABM affects patients with risk factors,and is predominantly due to Strep. pneumoniae. This age group has a higher mortality rate, which is associated with advanced age and development of complications.

Surveillance forStreptococcus pneumoniaeMeningitis in Children Aged &lt;5 Years: Implications for Immunization in Uganda

Affordable pneumococcal conjugate vaccines will soon become available to developing countries through the Global Alliance for Vaccines and Immunization. Data on Streptococcus pneumoniae meningitis epidemiology in Uganda will assist decision makers in determining the best national vaccine policy. We reviewed acute bacterial meningitis surveillance data for children aged <5 years from 3 sentinel surveillance sites in 3 Ugandan districts collected from 2001 through 2006. Serotype and antibiotic-resistance testing were performed on pneumococcal isolates collected from 2005 through 2006 from the Kampala district in the tropical central region of Uganda. Minimum pneumococcal meningitis incidence estimates were calculated for a portion of the Kampala district and all of the Gulu district, where case ascertainment was more complete. At the 3 sites, 14,388 probable acute bacterial meningitis cases were observed. The most common cause identified was S. pneumoniae (n = 331; 35% of all confirmed cases), which had an overall case fatality ratio of 19%. Yearly pneumococcal meningitis incidence was 3-20 cases per 100,000 population in Kampala versus 28-42 cases per 100,000 population in Gulu. The most commonly identified serotypes were 6A/6B (40%); 43% of isolates were serotypes that are in the available 7-valent pneumococcal conjugate vaccine and 70% are in the proposed 13-valent pneumococcal vaccine. Twenty-five isolates (83%) had intermediate resistance to penicillin but none were fully resistant. Pneumococcal meningitis is common and severe in Uganda, indicating a role for the pneumococcal conjugate vaccine.

Surveillance of Acute Bacterial Meningitis among Children Admitted to a District Hospital in Rural Mozambique

Acute bacterial meningitis (ABM) remains an important cause of mortality among African children. Epidemiologic data with regard to ABM infection are necessary for prioritizing public health interventions. We strengthened hospital-based surveillance of ABM among children admitted to Manhiça District Hospital (Maputo, Mozambique). Cerebrospinal fluid (CSF) samples were collected from children admitted to the hospital who met clinical criteria of ABM. Laboratory determinations were performed. Clinical information and outcome of cases were recorded. During the first 12 months of surveillance, which began in January 2006, CSF samples were collected from 642 children <15 years of age with suspected meningitis (18% of all pediatric patients admitted to the hospital during that time). ABM was confirmed in 43 (7%) of the 642 cases. Haemophilus influenzae type b (Hib) (14 cases), pneumococcus (9 cases), and meningococcus (7 cases) represented approximately 70% of confirmed cases. Four of the 9 pneumococci were serotypes covered by the 7-valent pneumococcal conjugate vaccine. The case fatality rate among patients with ABM was 24% (8 of 33 with known outcome); an additional 8 patients left the hospital before discharge. The incidence of ABM was 85 per 100,000 population, which peaked at 2-12 months of age at 1078 cases per 100,000 population. All 9 pneumococci isolates were susceptible to chloramphenicol, and 8 were susceptible to penicillin (the additional 1 had intermediate resistance). For the 10 Hib isolates tested, only 1 was susceptible to chloramphenicol, and 5 were susceptible to ampicillin. These data reinforce the importance of ABM as a cause of hospital admission and death in rural sub-Saharan Africa. Most observed ABM cases could have been prevented by current pneumococcal and Hib conjugate vaccines.

Diagnostic risk factors to differentiate tuberculous and acute bacterial meningitis

The objective of this study was to identify independent predictor factors for diagnosis of tuberculous meningitis and develop a clinical prediction tool based upon a set of simple clinical and laboratory parameters in our local population. Clinical and laboratory features were compared in 68 patients with tuberculous meningitis and 123 cases of acute bacterial meningitis in 3 referral centres for tuberculosis in south-eastern Iran. Twenty-two clinical and laboratory features were analysed. Based on the best-fitted model a receiver operating characteristic curve with the highest surface under the curve was constructed. Disease duration before diagnosis (>or=5 d) had the highest odds ratio of 21.9. Age over 30 y, CSF leukocyte count <or=1000 x 10(3) cells/ml and CSF lymphocytosis >or=70% were placed after disease duration with odds ratios of 5.1, 3.7 and 2.6, respectively. Sensitivity, specificity and likelihood ratio for a positive test in this model were 84%, 88% and 7.4, respectively. The area under the ROC curve was 0.92. It appears that a single model can not predict TBM diagnosis in different populations. Using clinical and laboratory parameters may facilitate empirical diagnosis of TBM in endemically low income countries with limited microbiological diagnostic facilities.

Klebsiella Meningitis

Acute bacterial meningitis is a severe CNS infection occurring mostly in infants and older children. Bacterial meningitis caused by gram-negative bacteria is usually fatal. Klebsiella pneumoniae is an uncommon gram-negative bacteria causing meningitis with a poor outcome. Though the commonest presentation of bacterial meningitis is fever, patients usually seek medical attention for uncontrolled seizure and features of raised ICP. The commonest complications of gram-negative bacterial meningitis including Klebsiella meningitis are subdural hygroma / empyema, hydrocephalus, infarcts (both arterial and venous) and cortical blindness due to hypoxic ischaemic insult. MRI is the best modality for evaluating these patients for early diagnosis. Early institution of treatment significantly reduces the mortality and morbidity. We describe a case of acute bacterial meningitis caused by Klebsiella pneumoniae with MR evidence of sinus thrombosis, venous infarcts and subdural hygroma.